Early Childhood Health Outcomes following in Utero Exposure to Influenza Vaccines: A Systematic Review

Abstract

CONTEXT: Vaccination during pregnancy is an effective strategy for preventing infant disease; however, little is known about early childhood health after maternal vaccination. OBJECTIVES: To systematically review the literature on early childhood health associated with exposure to influenza vaccines in utero. DATA SOURCES: We searched CINAHL Plus, Embase, Medline, Scopus, and Web of Science for relevant articles published from inception to July 24, 2019. STUDY SELECTION: We included studies published in English reporting original data with measurement of in utero exposure to influenza vaccines and health outcomes among children ,5 years of age. DATA EXTRACTION: Two authors independently assessed eligibility and extracted data on study design, setting, population, vaccines, outcomes, and results. RESULTS: The search yielded 3647 records, of which 9 studies met the inclusion criteria. Studies examined infectious, atopic, autoimmune, and neurodevelopmental outcomes, and all-cause morbidity and mortality. Authors of 2 studies reported an inverse association between pandemic influenza vaccination and upper respiratory tract infections, gastrointestinal infections, and all-cause hospitalizations; and authors of 2 studies reported modest increased association between several childhood disorders and pandemic or seasonal influenza vaccination, which, after adjusting for confounding and multiple comparisons, were not statistically significant. LIMITATIONS: Given the small number of studies addressing similarly defined outcomes, metaanalyses were deemed not possible. CONCLUSIONS: Results from the few studies in which researchers have examined outcomes in children older than 6 months of age did not identify an association between exposure to influenza vaccines in utero and adverse childhood health outcomes.